Ramcoa - Blog Posts
Citing outdated research is something I've started seeing a lot of lately. This time I will focus on people utilizing Kluft's 1988 Complex MPD paper to state that polyfragmentation can be as low as part counts in the 20s, that polyfragmentation is "poorly defined and debated," and that severe abuse does not need to occur for polyfragmentation to develop. So let's break this down.
Research is considered outdated if it is 10+ years old (and in some fields, anything 5+ years old). This paper was published 34 years ago.
Kluft's sample was 26 people with 26+ parts, 24 of which are AFAB and 2 are AMAB, 94% white. This is extremely small for a research study and not At All representative of any population.
In the abstract of the paper it states this: "48 of the 76 cases reviewed [...] had dual (2) personalities. Another 12 had 3 personalities. Only 1 individual, a patient with 12 personalities, had more than 8." Emergent research at the time was beginning to show higher parts counts--it cites several authors that put the average as 2-10, 6.3, 13.3, 13.9, 15.4, and 15.8. All of these studies had sample sizes less than 100 (mostly sub-50) except for the 15.8 number which had a sample size of 355. Kluft outright states that alter count is being investigated at that point. Note the vast majority of these studies, including the emergent research, output a lower alter count than is considered average today.
Kluft states that "Somewhat arbitrarily, [he] defined extreme complexity as the presence of at least twice as many alters as the upper limit of the modal range of 8-13, ie 26 or more." Key note here is that this Kluft's personal definition of complexity (not a widespread consensus) at a time when alter count was being openly investigated as essentially an unknown (he is using the upper limit as in the extreme end of averages per the previous emergent research indications, not that this was now widely considered the average alter count). Kluft was one of the very few people who even dealt with complex cases, with most of his colleagues opting to pass them onto him (as is noted in the paper), so essentially there was very little besides his own personal opinion to go off of.
Kluft notes that his observed rate of seeing complex MPD cases "constitute approximately 15-20%" of his patients, and that his "experience with very complex cases began in 1975." This means that of the cases he was seeing over the past decade, only 15-20% of his DID cases had 26+ parts. Or, 80-85% of his clients had fewer than 26 parts.
Kluft's phrasing in this paper that "chaotic and unsafe" home environments are a pathway to complex MPD has been used lately as "proof" that polyfragmentation does not need to occur from RAMCOA or severe abuse settings and can come from simply having an unstable home environment. This is a cherry-picked phrase and should not be used as evidence, because of the next point:
His findings for people with 26+ parts: 100% experienced "long-standing severe abuse." 46% had abuse histories that were documented legally in the 70s or corroborated by witnesses. It is nearly impossible to win a court case NOW against your abuser, much less in the 70s, and having witnesses to abuse is also a marker that the abuse was severe as abusers tend to abuse when others aren't around--for them to escalate is heavy. Not to mention the 70s were much stricter about what was considered abuse. 92% were incest survivors. 58% experienced "vicious torment." 35% were RA survivors. The exact percentage isn't listed but Kluft states that in addition to the 35% RA survivors in his sample, another 1/3rd (~33%) stated that others "manipulated their condition"--due to his grouping the two together I am inclined to think that there were likely overlaps in experience with RA and this, though we can't be sure. It's important to keep in mind here that the alter count is 26+.
What this study states is not that polyfragmentation is ill-defined in 2022. What it states is that in the 1980s, researchers were still trying to figure out what the average alter count even was. Much less polyfragmentation.
This study states that among a small group of people with 26+ parts, all of them had severe abuse histories and the overwhelming majority were incest survivors. This is evidence AGAINST the claim that polyfragmentation can occur in merely unstable households, not for it. Its evidence is that severe abuse is needed to develop above average alter counts, quoting Kluft with the phrase "the more traumata, the more alters." The fact that in a study for 26+ parts, over 1/3rd were RA survivors is a significant marker of this.
Not only this, but it is evidence AGAINST the idea that high alter counts in DID are common at all. If 80-85% of Kluft's patients had under 26 parts, it would indicate that above average alter counts in the 26+ count are a minority and that would indicate that having 100+ parts would be even more so.
Now, current evidence does not support the idea of a tit-for-tat "every trauma = another alter" idea that Kluft put forth. Current evidence shows that 50% of people with DID have 10 or fewer parts, which doesn't discount Kluft's experience of 80-85% of cases having fewer than 26, but does make it more unlikely given our higher average alter count now (as in, it is likely a higher number of people have 26+ parts than Kluft thought). Currently there is a stable definition of polyfragmentation as 100+ parts (with implied complexities), for the past ~15+ years, through the training provided by OEA SIG of the ISSTD and various texts including Christiane Sanderson's Counseling Adult Survivors of CSA. But this is why we should not use decades old research as if it wholly relevant--we can use it as a reference point but it is not accurate or up to date. It's also why cherry-picking phrases in research can lead one to wildly different conclusions than what it actually stated.
I am just going to say this outright and bare with me until the last paragraph. The idea that "the few people who are faking this disorder aren't actually hurting real people with DID or taking away resources" is demonstrably false. I check around sometimes for other people looking for dissociative specialists and ever since ~2019/8, if I call and ask a therapist if they have experience with DID their questions are "does this person spend a lot of time on social media" and "have they actually been diagnosed with DID before." I've met therapists who took their dissociation specialty off of their websites because they kept getting tons of calls from people who were seeking a diagnosis and they could not keep up.
This trend where large amounts of people are claiming to have RAMCOA and polyfragmentation within the past few years, which a significantly smaller number of specialists believe in and treat, IS going to detrimentally affect survivors even quicker and harder than general DID where there are a larger amount of people involved both professionally and not. I called this a few years ago that sometime in the future polyfragmentation would be commonly considered a "fake marker" (just as prior community trends turned into "fake markers" like introjects and kid parts) and that's already started.
We need to be able to talk about community issues like this from a practical perspective for people who need those resources, without it turning into a validation discussion or a discussion about malingering or pointless discourse. We need to step away from "shoulds"--yes it is true that practitioners should not let these things affect their overall care, but it does and simply saying it should not be that way doesn't fix anything. We need practical discussions that say "We are at this point. Now what?"
Thank you for running this blog. I was held in troubled teen industry facilities for all of my teenagerhood, and am severely traumatized as a result, and it's been extremely hard to find words to describe what I went through to other systems or to trauma therapists.
It feels "too much", like there's no way this could all have happened to me, and I've been accused of lying about the organized abuse that went on there. Sometimes it feels almost like i AM lying, though I know I'm not.
Although feeling like I have "too much" trauma is something that I have to continue working on personally, I want to say thank you for pointing me in the direction of a framework that I can research and use that fits me more than any other one I've seen before.
I wish that none of us went through the horrors we went through, but I'm glad that there's a community out there and people talking about the things that have affected me. Thank you again for what you do running this blog.
Before anything else — thank you. This is an incredibly kind message and I'm really glad that you could find solace in this blog. I aim to provide resources that may not be (physically or emotionally) acessible otherwise, and highlight lesser-discussed aspects of RAMCOA.
The troubled teen industry is definitely part of the wider picture of organized abuse, and I wish it was put in that context more. Unfortunately, most discussions of RAMCOA focus on early childhood manifestations, and situations primarily focused on adolescents, adults, seniors aren't as referenced. Basically, the older the victim, the less likely it is to be included in definitions of RAMCOA; which is a shame, because those perspectives are crucial. Abusive care homes & inpatient facilities, prisons, and yes, troubled teen facilities are all forms of organized abuse in my mind, but the strong correlation with pedophile rings and cults has... Alienated? Many people from describing their experiences as OA.
I totally understand the feeling of having "too much trauma", and I feel like many survivors in general, not just ones of RAMCOA, can relate to that sentiment. "It's just too unlikely for all these things to have happened," I'll say to myself, "I must be exaggerating." Something that's helped me is the idea that some predators can smell blood in the water, and if all you know is hardship, it's hard to break out of hardship. Experiencing layers of trauma isn't... Rare, and you're not lying about it.
Once again, thank you. If you need any resources specific to the troubled teen industry, let me know. There's not a ton of research on it in the context of RAMCOA like I said, but I'm sure I'll find something of use.
Wishing you a gentle and fulfilling recovery. Aisling
Rant
CW: This post will discuss RAMCOA (not in detail) and the mistreatment of RAMCOA survivors in the OSDDID community. Please read with caution.
RAMCOA survivors are treated terribly in the system community. Your trauma is seen as larger than life, not real/fictional, or too bad to talk about. Hell, I'm nervous to even mention this kind of thing because it's so heavily seen as taboo and dangerous to talk about to other people. We're not allowed to share our stories because our trauma(s) are "too severe" and "dangerous" that we're not allowed to share what we went through. I have seen people say not to Google it, and if they do that they'll be more likely to be a victim as well. Which.. just isn't true. Apply that to any other trauma where Googling the definition makes it more likely for you to experience it. Make it make sense! You don't have to share your story in any case scenario, but why are we not ALLOWED to? Why is our trauma that different? It's isolating us, which is what my abusers would've wanted. I've been told that my trauma is fake, and no wonder! We're not allowed to talk about it. Ever. Let us talk about it if we feel comfortable to, it's not your choice, it's OURS.
Thisssssss
Tried reading this shit. Absolutely made me nauseous. Sick to my stomach. This is all taken out of context. And also, in alterhuman communities, which I was part of, people claiming to have DID or DDNOS because of it were very frequently shunned. I would continue but I'm sure the reblogs will.
I need breakfast.
Warning for anyone triggered by endo rhetoric: this is nothing but that